Definition

• Weaning means replacing breastfeedings with cup or bottle feedings. It means breastfeeding has been discontinued.
• Weaning can also mean the gradual decrease in breastfeedings as solid foods are introduced after 6 months of age.
• Weaning usually occurs easily and smoothly.
• Weaning can be either infant-led or mother-led.

Health Information

Weaning at 9-12 Months

• Most children normally show less interest in breastfeeding between 9 and 12 months of age. They often lose interest in the breast if they are also taking spoon feedings.
• Many children wean themselves around 12 months.
• For easy weaning, follow your baby's lead.
• For later mother-led weaning, it needs to be done gradually.

Weaning at a Later Date after 12 Months

• After the age of 12 months, the parent often has to start the weaning process. The child will usually be accepting.
• After 18 months of age, some children may protest weaning. Reason: Breastfeeding is no longer just about hunger. It has become emotionally important to the child.
• Continuing to breastfeed after 12 months is a personal decision. So is when to wean.
• The AAP recommends mothers breastfeed (or use pumped milk) until 12 months. After 12 months, they recommend continued nursing "if you and your baby desire it". The AAP does not recommend an upper age limit for weaning from breastfeeding.

Prevention of Sleep Problems and Feeding Problems

The following 2 recommendations are made to prevent potential feeding associated problems:

• Nursing a baby to sleep is discouraged. It interferes with learning self-soothing behavior. It will cause persistent sleep problems. Exception: first 2 months.
• Comfort nursing is discouraged. Comfort nursing is very brief nursing to calm a fussy child or one who seems unhappy, but not hungry. It will make later weaning more difficult.
• If your doctor or lactation advisor disagree, the choice is yours.

Care Advice

Preparing Your Child for Weaning (Child- or Mother-Led)

1. Breastfeeding During the First Month:
   • During the first month, expect your baby to feed every 2 to 3 hours. This is usually about 8 - 12 times/day.
   • During the day, awaken your baby to feed if 3 hours have passed since the last feeding.
   • At night, awaken to feed if 4 hours have passed since the last feeding.
2. Avoid Excessive Breastfeeding After the First Month:
   • After the first month, if your baby is gaining weight well, feed on demand (on cue). Do not feed if less than 2 hours have passed. Do not awaken for feedings.
   • After 2 months, do not feed if less than 3 hours have passed since the end of the last feeding.
   • After 6 months of age, do not feed if less than 4 hours have passed.
   • Keep breast feedings to 4 times a day. Be sure 3 of them are given at mealtime with baby foods (solids).
   • Your baby can have the fourth feeding as the first step in the bedtime ritual.
   • Don't nurse for between meal snacks.
   • Don't nurse to sleep at bedtime or naptime.
   • Try to stop all night feedings by 6 months.
3. Introduce an "Educational Bottle" at 1 Month:
   • After nursing is well established, offer a bottle of pumped breastmilk or 1 ounce of formula. In this way, your baby gets used to the bottle and the artificial nipple. Ideally, this is done soon after 4 weeks.
   • Frequency of bottle feedings: Start with once a day. Once your baby accepts bottle feedings, offer once every 3 days or so. Reason: Will continue to accept milk from a bottle.
   • If you wait too long (such as 8 weeks), some babies will reject bottle feedings. It could take several weeks to learn to accept the bottle.
   • Bottle acceptance allows you to leave your baby with a family member or a sitter. It's also essential if you plan on returning to work or school.
4. Hold Your Child for Crying not due to Hunger:
   • Hold and comfort your child without feeding if they are fussy and not hungry. Assume hunger is not the cause if it's been less than 2 hours since the end of the last feeding.
   • Unexplained fussing and crying is common in the first 3-4 months. Many babies become fussy when they need to fall asleep.
   • Try swaddling, gentle rocking, different sounds and other techniques. Learn what works best to soothe your baby.
   • If you always feed your child when fussy, you have introduced them to comfort nursing.
   • Your baby may also come to expect to be nursed every time they are held. That can become a habit.
5. Use a Pacifier When Your Baby Needs to Suck but is Not Hungry:
   • Some babies have a high suck drive. Learn to recognize when your baby just needs to suck.
   • The best way to tell is that it has been less than 2 hours since the end of the last good feeding.
   • At these times, offer a pacifier instead of nursing.
   • Feeding your baby every time he needs to suck can lead to a habit of frequent brief feeds. This makes it hard to sleep longer intervals at night.
   • After teeth come in, a teether may be helpful for any fussiness.
6. Don't Breastfeed or Hold Until Asleep:
   • To have a good sleeper, place your baby in the crib drowsy but still awake.
   • Don't breastfeed or hold until asleep. All sleep experts agree on this advice for preventing sleep problems.
   • Your baby needs to learn how to put themself to sleep. Self-soothing is a critical skill. If they don't, they will cry and want to be nursed after normal night wakings. This sleep problem will require your presence during the night.
7. Introduce a Sippy Cup at 6 Months of Age:
   • Exposure to cup feedings will make weaning easier.
   • Delaying cup feedings past 9 months makes your child less willing to try them.
   • At first, offer the cup after your baby has sucked some from your breast. This might be the only way your baby will accept the cup.
   • By 9 months of age, offer pumped milk from a cup before breast feedings. You can also use formula if that is easier.
   • If you stop breastfeeding after 9 months, you may be able to wean your baby directly to a cup.
   • Caution: If younger than 9 months, wean to a bottle and not to a cup. Most young babies can't drink well enough from a cup to get adequate nourishment.
8. Introduce Baby Foods (Solids) from a Spoon at 6 Months:
   • Starting foods earlier is not recommended for breastfed babies. It's not needed for growth and can cause gagging.
   • Delaying solids past 9 months runs the risk that your baby will refuse solids.
   • Finger foods can be introduced whenever your child develops a pincer grasp. This is usually between 9 and 10 months of age. Once your child can use finger foods, include them at the table during mealtime. Your baby will probably become interested in the foods that they see you eating. As a result, your baby will want to try other foods as well as nursing.
9. If You Want to Wean Your Baby at 1 Year - Helpful Tips:
   • Children normally show less interest in breast feedings between 9 and 12 months.
   • Start with any feeding when your child shows a lack of interest in the breast. Don't miss this window of opportunity for child-led weaning.
   • You can offer pumped breast milk or formula in a cup instead.
   • You can tell that your baby is ready to begin weaning when they:
   • Refuse the breast.
   • Nurse for only a few minutes and then want to play.
   • Become more interested in the world around them than breastfeeding.

Call Your Doctor If

• After 2 months, needs nursing to fall asleep
• After 6 months, can't sleep 6 hours without a feeding
• After 7 months, won't accept baby foods
• After 9 months, won't accept a cup for some feedings
• You want help with weaning
• You think your child needs to be seen
• You have other questions or concerns

Pediatric Care Advice

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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